Menu ENN Search

Tackling overweight and obesity in Ecuador : Policies and strategies for prevention

Angélica Ochoa-Avilés is a professor/researcher at the Food Nutrition and Health Unit, Department of Biosciences, Cuenca University, Ecuador.
Gabriela Rivas-Mariñ
o is the coordinator of the National Nutrition and Food Security Unit at the Ecuadorian Ministry of Public Health.
Roosmarijn Verstraeten is an independent nutrition consultant and collaborator at the Department of Food Safety and Food Quality, Ghent University, Belgium.


Child and adolescent nutrition and health
in Ecuador

Ecuador is an Andean upper middle-income country with 16.5 million inhabitants and a life expectancy of 76 years. An estimated 63% of the population live in urban areas, 72% are ‘mestizos’ (of mixed Spanish and indigenous descent) and 7% are indigenous people. Over the past decade, Ecuador has experienced a higher burden of noncommunicable diseases (NCDs) such as diabetes, hypertension, stroke, ischemic heart disease and pneumonia, which are now the leading causes of death (Instituto Nacional de Estadísticas y Censos, 2013). Overweight and obesity are widely prevalent across all age groups (8.6% of children under five years old; 29.9% of school-age children; 26% of adolescents; and 62.8% of adults) (Freire, Belmont et al, 2013).
Students learn about healthy eating during the ACTIVITAL intervention
In addition, around 13% of households have both an overweight or obese mother and a child under five years old who is stunted, which shows how the double burden of malnutrition and overweight can coexist in the same household. Worryingly, stunting and anaemia among children under five are 25.3% and 25.7% respectively; both conditions are higher among indigenous groups (42.3% and 40.5% respectively) (Freire, Belmont et al, 2013). Exclusive breastfeeding occurs only in 43.8% of children under six months old; this number decreases among women in the higher income groups (31.9%) and in those with of a higher education level (29.2%) (Freire, Belmont et al, 2013).
In response to these public health challenges, the Government of Ecuador has adopted a national nutrition agenda that aims to achieve the following goals by 2025: to eradicate stunting among children under two years old; to reach 64% exclusive breastfeeding for infants during the first six months of life; and to decrease the prevalence of obesity and overweight among children aged 5 to 11 years old to 26%. This article describes the strategies that have been implemented to reduce the rapid increase in obesity among children of school age.

Food labelling regulations

A key policy in the fight against obesity is implementation of traffic-light labelling of processed foods and beverages. This system applies to all the pre-packaged, processed food items containing artificially added fat, sugar or salt, produced nationally or internationally and sold in Ecuador. The labels classify processed food as having a low, medium or high content of total fat, sugars and salt, as described in Figure 1. The label is a simple and useful tool that can help people
choose what they buy and eat. An evaluation showed that children, adolescents concerned about health issues and adult women pay more attention to the label when selecting products (Freire, Waters et al, 2016). Moreover, the population has adjusted eating behaviours in response to a
red label, with reported reductions, for example, in the frequency and amount of consumption of such food items. Instead, people prefer food options with yellow and green labels and natural foods and beverages such as fruits, vegetables and water (Freire, Waters et al, 2016).

Of great importance to Ecuador, the traffic-light regulations have been recognised by the Pan-American Health Organization 55th Directive Council as a public health achievement in the region and have received endorsements from organisations including the NCD Alliance, the Healthy
Latin American Coalition and the World Cancer Research Fund.

Regulations for in-school food tuck shops

In April 2014, the Ministry of Health (MoH) issued an agreement to regulate the functioning of in-school food tuck shops, which established regulatory committees at national and local level to protect the health of school children. To prevent possible conflicts of interest, the food industry does not form part of these regulatory committees. This is in order to overcome constant industry pressure to block the implementation of the agreement. The regulations prohibit the sale of:

(i) any product with a high sugar, salt or fat content (with a red traffic light); (ii) products containing artificial sweeteners and caffeine; and (iii) energy drinks. In addition, food tuck shops are obliged to sell fruits and vegetables and to offer free, safe water. According to MoH 2016 national reports, 70% of schools comply with the bans relating to red traffic lights and 95% comply with the obligation to sell fruit and vegetables. A more in-depth evaluation of the strategy is planned in 2017.

Physical activity lessons and food taxes

Since 2014, in parallel with the in-school food tuck shop regulations, the Ministry of Education (MoE) stipulated an increase in physical activity lessons from two to five hours per week in the national education system. Unfortunately, neither the results nor an evaluation of this initiative have been reported since its implementation, although the MoH is planning to monitor the initiative in 2017. In May 2015, Ecuador’s National Assembly approved a law to increase taxes on sugary and non-sugary drinks. This fiscal measure imposes a tariff of US$0.18 (18 cents) per 100 grams
of sugar added to processed beverages. For non-sugary drinks, including those that use artificial sweeteners, a rate of 10% of the price is imposed.

Healthy eating and physical activity in
schools: the ACTIVITAL programme

A research group from Cuenca University, in collaboration with researchers from Ghent University in Belgium, implemented the ACTIVITAL programme from 2009 to 2012 to improve dietary and physical activity behaviours among 1,430 school-going Ecuadorian adolescents aged 11-16 years.
The programme involved 20 schools in the urban area of Cuenca, Ecuador’s third-largest city. It consisted of interactive classes taught by schoolteachers on healthy eating and physical activity; participatory workshops with parents and food tuck shop staff on topics such as healthy eating,
physical activity, portion sizes, and food safety; preparation of healthy breakfasts; motivational talks by famous local athletes; and the creation of walking trails in the schools.

These strategies were implemented in ten schools, while the normal curriculum was maintained in the other ten. ACTIVITAL was found to be effective in decreasing added sugar and processed food intake during snacks and reducing waist circumference and blood pressure among members of
the intervention group. The intervention ameliorated the trends towards lower fruit and vegetable intake and less physical activity during adolescence (Ochoa-Avilés, 2015).
The following challenges were identified during the implementation and evaluation of ACTIVITAL:
• As the programme was not included in the school curriculum, teacher participation was voluntary rather than compulsory, but researchers could not wait for the revised curriculum due to funding constraints;
• Portion sizes of dishes offered by the food tuck shops were large, with high levels of carbohydrates, and low in protein, fruit and vegetables, but there was strong resistance to reducing portion sizes from staff and teachers for cultural reasons and because of the simultaneous initiation of the in-school food tuck shop regulations (described above). A lesson learnt is the
importance of involving all stakeholders in the design, implementation and evaluation of policies to enable the acceptance of feasible and locally adapted strategies.
• Despite recognition of its positive results, ACTIVITAL has not been scaled up due to a national agenda focus that prioritises under 12-year-olds rather than adolescents and the challenge of the MoH and MoE in implementing a joint strategy, since each ministry has different objectives,
frameworks and authorities, and budget issues.

Next steps

Although actions have been taken to promote healthy eating and physical activity, more efforts are needed. Having a national agenda along with a strong political will has helped Ecuador put in place powerful strategies at the national level, but these achievements need protection by: (i) ‘scaling up’
the regulations into laws; (ii) reinforcing the surveillance and monitoring systems for the regulations; (iii) scaling up local, successful interventions; and (iv) increasing the national budget for health promotion.

Positive outcomes of the ACTIVITAL research are a new study aimed at understanding the obesity problem among younger children and documenting the perceptions of in-school food tuck shops, and a more active relationship between policymakers and researchers, with academic involvement in preparing Ecuador’s Nutrition Guidelines.



Freire WB, Belmont P, Mendieta M, Silva M, Romero N, Sáenz K, Piñeiros P, Gómez L, Monge R. Resumen Ejecutivo Tomo I. Encuesta Nacional de Salud y Nutrición del Ecuador. In: Ministerio de Salud Pública INdEyC, editor. Quito, Ecuador, 2013.

Freire WB, Waters WF, Rivas-Mariño G, Nguyen T, Rivas P. A qualitative study of consumer perceptions and use of traffic light food labelling in Ecuador. Public Health Nutrition. 2016:1-9.

Instituto Nacional de Estadísticas y Censos. Presentación Defunciones 2011 Ecuador. Instituto Nacional de Estadísticas y Censos; 2011 (updated 07/01/2013.)

Ochoa-Avilés AM. Cardiovascular risk factors among Ecuadorian adolescents: a school-based health promotion intervention. Ghent University, 2015.

More like this

FEX: Preventing teen pregnancies and supporting pregnant teenagers in Ecuador

View this article as a pdf By Sara Bernardini, Geraldine Honton, Laura Irizarry, Jesús Sanz, Estefanía Castillo, Carmen Guevara and Lorena Andrade Sara...

NEX: Adaptation and mitigation of climate-change effects on food and nutrition security in Honduras

View this article as a pdf Lisez cet article en français ici José Lino Pacheco is Director of the Food and Nutrition Security Technical Unit, Secretary of...

FEX: Determinants of adolescent nutritional status and practices in Burkina Faso: A pooled secondary analysis

View this article as a pdf Lisez cet article en français ici By Deepali Godha, Maurice Zafimanjaka, Estelle Bambara, Nathalie Likhite and Manisha Tharaney. Deepali...

NEX: UN Decade of Action on Nutrition: Brazil, Ecuador and Italy make commitments

View this article as a pdf Lisez cet article en français ici Trudy Wijnhoven is a Nutrition Officer and the technical focal point for the UN Decade of Action on...

NEX: Meeting the health and nutrition needs of adolescents and youth in Ethiopia

View this article as a pdf Lisez cet article en français ici Meseret Zelalem is a paediatrician and Director of the Maternal and Child Health Directorate of the...

FEX: ‘Vida Saludable’: Healthy living is on the school curriculum in Mexico

Read a Spanish version of the article here View this article as a pdf By Angélica Hernández, Gabriela Tamez Hidalgo and Anabel Fiorella...

FEX: Impact evaluation of cash, food vouchers, and food transfers among Colombian refugees and poor Ecuadorians in urban Ecuador

Summary of evaluation1 Evaluation headlines: Levels of food insecurity and associated anaemia are high amongst Columbian refugees and poor Ecuadorians in the northern...

FEX: When Are We Going to Teach Health?

View this article as a pdf Van Dusen, DP (2020) When Are We Going to Teach Health? Chapter 9: “Celebrating Nutrition: Involving Everyone Is Free and Fun”....

FEX: Systems approach to prevent all forms of malnutrition among children 5-19 years

View this article as a pdf By Deepika Sharma and Vilma Tyler Deepika Sharma is a Nutrition Specialist and the focal point for the nutrition of children in school-age and...

NEX: Editorial

Listen to an interview with the editors (podcast) on ENN's MediaHub Welcome to this eighth issue of Nutrition Exchange (NEX), in which we have widened our geographical...

FEX: Cash, food or vouchers? Evidence from a randomised experiment in northern Ecuador

Summary of research1 Location: Northern Ecuador What we know: There is ongoing debate on the most effective form of food assistance: cash, food vouchers or food...

en-net: Should rations be adapted to provide a protective diet?

Question escalated to the prevention workstream of the Wasting TWG Should rations be adapted to provide a protective diet? What are the most important messages to put out...

FEX: Improving the nutritional well-being of school-age children through the Nutrition-Friendly Schools Initiative (NFSI) in the State of Palestine

View this article as a pdf By Selena Bajraktarevic, Kanar Qadi, Amani Badwan, Younis Awadallah and Rania Abueita This Field Exchange report is a summary of the cumulative...

FEX: Evolution of WFP’s food assistance programme for Syrian refugees in Jordan

By Edgar Luce For the past two years, Edgar Luce has been working for WFP Jordan as a Programme Officer by monitoring operations, writing reports and acting as the VAM...

FEX: The triple burden of malnutrition among adolescents in Indonesia

View this article as a pdf Rah, JH, Melse-Boonstra, A, Agustina, R, van Zutphen, KG and Kraemer, K (2021) The triple burden of malnutrition among adolescents in Indonesia....

FEX: Concerns that The Lancet double-burden series may undermine moderate wasting treatment

View this article as a pdf By Mark Manary, Donna Wegner, D Taylor Hendrixson, Rebecca Roediger, Meghan Callaghan Mark Manary is one of the world's foremost experts in...

FEX: Promoting youth leadership on nutrition through junior parliamentarians and junior council engagement in Zimbabwe

View this article as a pdf By Progress Katete, Kudakwashe Zombe and Dexter Chagwena Progress Katete is a United Nations Volunteer Nutrition Specialist at UNICEF. She has...

FEX: UNICEF programming guidance: Nutrition in middle childhood and adolescence

View this article as a pdf UNICEF (2021). UNICEF programming guidance: Nutrition in middle childhood and adolescence. Available from:...

FEX: Local Production of Processed complementary food: World Food Programme experience

Summary of published review Blended food is often used in supplementary feeding programmes. Fango, Ethiopia, 2000. Pieternella Pieterse (Concern) Pieter Dijkhuizen has been a...

FEX: Regional Perspective: Latin America and the Caribbean (LAC)

Yvette Fautsch Macías is a Nutrition Specialist at the UNICEF Regional Office for the LAC Regional Office (LACRO) Paula Veliz is a Regional Nutrition Specialist at...


Reference this page

Angélica Ochoa, Gabriela Rivas-Mariño and Roosmarijn Verstraeten (). Tackling overweight and obesity in Ecuador : Policies and strategies for prevention. Nutrition Exchange 8, July 2017. p12.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.